Long-Term Results of Modified Fontan Operation for Single-Ventricle Patients Associated With Atrioventricular Valve Regurgitation

摘要

Measurements of AVVR and Ventricular FunctionOperative TechniqueCircular annuloplastyPartial annuloplastyEdge-to-edge repairValvoplastyStatistical MethodsResultsPatient CharacteristicsAVV Repair Surgical TechniquePatient Outcomes and Risk Factors for DeathReoperationVentricular Function Over TimeLatest AVVR Degree Obtained by EchocardiographyCommentTiming of Fontan Completion, Maturity of Pulmonary Vasculature, and Ventricular Function in Patients With AVVRMechanisms of AVVR and Treatment OptionsFuture AVVR StrategiesStudy LimitationsConclusionReferencesThe long-term outcome of modified Fontan operation concomitant with a valve operation for atrioventricular valve (AVV) regurgitation is not well described.MethodsBetween 1977 and 2003, 500 children who underwent modified Fontan operation were subdivided into 192 with AVV plasty (group P) and 308 without AVV plasty (group N). Factors associated with patient outcome were investigated retrospectively.ResultsSurgical techniques to correct valve incompetence included circular annuloplasty, partial annuloplasty with Kaye-Reed methods, edge-to-edge repair methods, and valvoplasty, which were combined according to the etiology of the valve lesion. The estimated actuarial survival rates at 10 and 20 years were, respectively, 82.0% and 76.6% in group P (p < 0.05) and 90.8% and 86.8% in group N (p?=?0.001). The estimated actuarial survival rates at 10 years among patients with AVV plasty did not show a statistically significant difference (circular annuloplasty, 79.0%; partial annuloplasty, 81.6%; edge-to-edge, 83.3%; valvoplasty, 82.6%; p?= 0.90). A Cox regression model revealed that a higher preoperative ventricular ejection fraction was associated with a significant reduction in long-term mortality in group P (hazard ratio, 0.921; 95% confidence interval, 0.873 to 0.972; p < 0.05). Each repair method showed acceptable durability at medium-term follow-up, without progression of lesions.ConclusionsGiven worse results with poor ventricular function, early intervention against valve pathology before development of ventricular failure may improve long-term outcomes. Multiple methods are appropriate for a variety of valve lesions; however, circular annuloplasty remains a reliable repair option due to its technical simplicity.CTSNet classification:21Atrioventricular valve (AVV) regurgitation (AVVR) has a severe impact on the outcome of the modified Fontan operation, despite improved perioperative care. Earlier reports demonstrate 10-year survival of patients with AVVR of 36% compared with 62.5% in those without it [